… the A.M.A. now represents only 19 percent of practicing physicians (that’s my calculation, which the A.M.A. neither confirms nor contests). Its membership has declined in part because of its embarrassing historical record: the A.M.A. supported segregation, opposed President Harry Truman’s plans for national health insurance, backed tobacco, denounced Medicare and opposed President Bill Clinton’s health reform plan…

He only gets partial credit for the explanation however. Membership fell because the AMA was more or less created to represent surgeons in their negotiations for procedural reimbursement. Non-proceduralists have a direct economic conflict with the AMA.

Kristoff continues …

… when the A.M.A. uses its lobbying muscle to oppose major health reform — yet again! — that feels like a betrayal…

… most physicians expect better as well, which is why the A.M.A. is on the decline.

“It’s what has led to the decline of the A.M.A. over the last half century,” said Dr. David Himmelstein, a Massachusetts physician who also teaches at Harvard Medical School. “At this point only one in five practicing doctors are in the A.M.A., and even among its members about half disagree with its policies.” To back that last point, Dr. Himmelstein pointed to surveys showing a surprising number of A.M.A. members who support a single-payer system.

For his part, Dr. Himmelstein co-founded Physicians for a National Health Program, which now has more than 16,000 members. The far larger American College of Physicians, which is composed of internists and is the second-largest organization of doctors, is also open to a single-payer system and a public insurance option. It also quite rightly calls for emphasizing primary care…

Physicians know that real health reform will be a mixed bag for them. Some things will get better, some things will get worse. Proceduralists will lose income, but primary care physicians might disappear. Or they might do relatively well. All physicians know is that the transition is going to hurt like hell.

I think if we could poll physicians (which is very hard to do) we’d find a majority do support major change – even though they’re going to get hurt in the process. Even many of the physicians who are likely to lose income (which translates to losing things like homes) may be more supportive than logic would dictate – especially if the transitions can be staged.